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Chronic Constipation, Irritable Bowel Syndrome With Constipation and Constipation With Pain/Discomfort: Similarities and Differences

Rey, Enrique MD, PhD1; Balboa, Agustín MD2; Mearin, Fermín MD, PhD2

American Journal of Gastroenterology: June 2014 - Volume 109 - Issue 6 - p 876–884
doi: 10.1038/ajg.2014.18
Functional GI Disorders

OBJECTIVES: Some patients with chronic constipation (CC) have abdominal pain and discomfort (painful CC) without fulfilling the criteria for irritable bowel syndrome (IBS). Our aim was to investigate similarities and differences among nonpainful CC, painful CC, and CC in patients with IBS according to prevalence, individual symptoms, associated factors, and impact on health-related quality of life and use of medical resources.

METHODS: We conducted a telephone survey of a random sample of the Spanish population (N=1500). Bowel symptoms were recorded using the Rome III questionnaire, health-related quality of life using the short form-12 (SF-12) and quality of live in constipation-20 (CVE-20) questionnaires, and self-reported constipation, lifestyle habits, and consultation behavior using anad hocquestionnaire.

RESULTS: The overall prevalence of CC was 19.2%, with prevalence by subgroups being 13.9% for nonpainful CC, 2.0% for painful CC, and 3.3% for CC in patients with IBS. CC was more prevalent among women at a ratio of 2.7:1. Subjects with painful CC and CC in patients with IBS were younger, reported more constipation, and had more symptoms than subjects with nonpainful CC. Age and physical activity were significantly associated with CC. Symptoms associated with consultation were abdominal pain and digitation. Nonpainful CC patients were more satisfied with laxative use than were the other subgroups. Subjects with CC showed a significant impairment in the physical and mental component of the SF-12 questionnaire.

CONCLUSIONS: CC appears to be a spectrum; most patients do not have abdominal pain/discomfort but others (with otherwise quite similar characteristics) are patients with IBS or are out of any established diagnosis.

1 Department of Digestive Diseases, San Carlos Clinical Hospital, Complutense University, San Carlos Clinical Hospital Health Research Institute (Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC)), Madrid, Spain

2 Service of Gastroenterology, Centro Médico Teknon, Institute of Functional and Motor Digestive Disorders, Barcelona, Spain

Correspondence: Fermín Mearin, MD, PhD, Service of Gastroenterology, Centro Médico Teknon, Institute of Functional and Motor Digestive Disorders, C/Vilana 12, E-08022 Barcelona, Spain. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at,

Received 26 April 2013; accepted 16 December 2013

published online 4 March 2014

© The American College of Gastroenterology 2014. All Rights Reserved.
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